Kognitive Entwicklung von Kindern mit benigner Epilepsie des Kindesalters mit zentrotemporalen Spitzen (Rolando-Epilepsie) – Ergebnisse einer aktuellen systematischen Literaturrecherche

Zusammenfassung

Die Rolando-Epilepsie (RE) ist eines der häufigsten Epilepsiesyndrome im Kindesalter. Aufgrund meist nur seltener Anfälle und des Ausbleibens von Anfällen nach der Pubertät wird sie vielfach als benigne betrachtet. Diese Begrifflichkeit wird jedoch in der jüngeren Literatur kritisch diskutiert, da bei RE-Patienten überproportional häufig Teilleistungsstörungen festgestellt wurden. Mit dem Ziel einer Zusammenstellung neuerer Daten zur kognitiven Entwicklung von Kindern mit RE erfolgte eine systematische Literaturrecherche in den Datenbanken PubMed und PubPsych zu klinischen Studien, die von 2009 bis 2015 publiziert wurden. Es fanden sich insgesamt 19 relevante Arbeiten.

Kinder mit RE zeigten auch in den neueren Studien durchgängig globale intellektuelle Leistungen im Normalbereich; in zwei Arbeiten waren ihre Leistungen aber signifikant schwächer als die der Kinder der Kontrollgruppe. Gehäuft ließen sich Teilleistungsstörungen im Sprachbereich (10 der 12 Studien zum Thema) sowie schulische Leistungsdefizite (6/8) finden. Bezüglich weiterer Teilleistungen und Störungen kognitionsstützender Funktionen (Aufmerksamkeit, Gedächtnis, visuelle/auditive Wahrnehmung/Verarbeitung, exekutive Funktionen) ist die aktuelle Befundlage aber uneinheitlich. Auch die Studienlage zur Entwicklung nach Remission der RE, zu Beziehungen zwischen klinischen/elektroenzephalografischen Parametern (z. B. EEG-Muster, Fokuslokalisation) sowie zur Wirksamkeit antiepileptischer Therapie mit dem Ziel einer Verbesserung kognitiver Leistungen ist weiterhin limitiert. In Arbeiten, in denen Untersuchungen mit fMRT und mit evozierten Potenzialen durchgeführt wurden, ergaben sich Hinweise auf eine funktionelle Reorganisation neuronaler Netzwerke bei RE.

Das erhöhte Entwicklungsrisiko bei Kindern mit RE legt die frühe Erfassung eventueller Entwicklungsdefizite mit dem Ziel adäquater Betreuung und Förderung nahe.

Abstract

Benign Rolandic Epilepsy (BRE) is one of the most common epilepsy syndromes in childhood. Although global intellectual performance is typically normal in BRE-patients, problems were found in specific cognitive domains. To summarize recent empirical findings concerning cognitive development in children with BRE a systematic literature search of clinical studies published between 2009 and 2015 was performed. 19 studies of relevance were found.

In most recent studies children with BRE consistently showed general intellectual performance within the normal range. However, in two of the studies patients showed a significantly poorer (but still normal) performance in comparison to controls. The studies provide clear indications for a high prevalence of impairments in language (10 out of 12 studies) and academic performance (6 out of 8 studies) in children with BRE. Regarding deficits in other cognitive domains (attention, memory, visual/auditory perception, executive functions) current findings are inconsistent. In addition, no clear results are found in studies examining cognitive development after remission of BRE. Studies on the relationship between selected clinical/electroencephalographic characteristics (e. g. EEG-patterns, focus lateralization) and cognitive performance and studies on potential benefits of anti-epileptic therapy for cognitive functions also have not yielded consistent results. Studies using fMRI and evoked potentials provide evidence for functional reorganization of neural networks in BRE.

Due to the developmental risks in children with BRE early cognitive assessment, early treatment and follow-up assessments are important.

Schlüsselwörter

Benigne Epilepsie des Kindesalters mit zentrotemporalen Spitzen - Rolando-Epilepsie - rolandiforme EEG-Muster - kognitive Entwicklung - kognitive Defizite - Teilleistungsstörungen

Key words

benign rolandic epilepsy of childhood with centrotemporal spikes - rolandic epilepsy - rolandic epileptiform discharges - cognitive development - cognitive deficits - specific developmental disorders

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